Study explores link between depression, anxiety and asthma in Puerto Rican children

Main Category: Respiratory / Asthma
Article Date: 02 Jun 2004 - 4:00 PDT

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Parents of Puerto Rican children are more likely than parents in other ethnic groups to report asthma among their children, and researchers wonder if the relationship between asthma symptoms and psychological problems may explain why.

The connections between asthma and psychological symptoms are complex, and it is difficult to disentangle what's really causing the various symptoms suffered by Puerto Rican children in this study, said Alexander Ortega, the study's lead author and associate professor of public health at Ohio State University.

His study found that children whose parents reported they had asthma were more likely than others to have a depressive disorder. Those children whose parents reported they had actual asthma attacks were more likely to have not just depressive disorders, but also anxiety disorders, such as separation anxiety.

However, Ortega said the reasons behind these associations are not yet clear.

"There's a lot of confusion as to what the symptoms of asthma really are, and it is easy to confuse some psychiatric symptoms with symptoms of asthma," Ortega said. "There's no standard way to diagnose the disease. A well-meaning parent may suggest to a pediatrician that her child has asthma, which could help lead to a misdiagnosis."

Ortega pointed out that asthma, panic attack and separation anxiety have similar symptoms, including shortness of breath, chest tightness and physical anxiety. This sometimes makes it difficult to determine which disorder a child may have, based on symptomatology alone.

The study appears in a recent issue of the journal Psychosomatics.

The researchers interviewed nearly 1,900 Puerto Rican children, ages 4 to 17, and their parents. The children lived in cities and rural regions in Puerto Rico.

For reasons that aren't quite clear, Puerto Rican children have significantly higher asthma rates than do children of any other ethnic group, including Mexican-American and other Hispanic children. Experts say the incident rate of asthma among Puerto Rican children is as high as 30 percent, compared to an average of 5 to 16 percent among other ethnic groups.

"One reason for such astoundingly high asthma rates is that Puerto Rican children and their families may have different perceptions of the symptom severity," Ortega said. "Or they might experience those symptoms differently."

There may also be cross-cultural differences in how Puerto Ricans interpret the terminology and symptoms associated with asthma.

By studying this population, the researchers hoped to tease out a clearer relationship between asthma, anxiety and depression.

Of the 1,900 children in the study, parents of about 600 children said their child had asthma, while parents of 400 of these children reported that their child had had an asthma attack.

"Again, it's difficult to diagnose asthma in the first place, so a parent may assume that her child's breathing difficulties are due to asthma when something else entirely could be going on," Ortega said.

Parents answered questions related to their child's asthma and if the child had ever shown signs of anxiety or depression. Children and their parents were asked to describe feelings related to anxiety and depression.

According to parent reports, children who had had an asthma attack had higher rates of depressive and anxiety disorders than did asthmatic children who had never had an attack and children who didn't have asthma.

Specifically, children who had had an attack were more likely to suffer from major depression along with symptoms of depression, including irritability, loss of interest in activity, weight gain or loss and fatigue. These children were also more likely to experience separation anxiety disorder and generalized anxiety disorder, or feelings of restlessness.

"It's possible that having an asthma attack, or the threat of having an attack, makes a child nervous about being away from his or her parents," Ortega said.

"The mechanisms behind asthma and mental illness are multiple and complex," Ortega said. "Children may fear the exacerbation of asthma symptoms, causing them to be anxious and fear separation from a parent. They may also feel distressed from internalizing the chronic burden of asthma.

"There's some evidence suggesting that psychiatric disorders in youth are related to the onset and persistence of asthma, so we need to think about creative ways for intervening."

Ortega conducted the study with researchers from Brown University, the University of Puerto Rico and Columbia University.

This study received support from the National Institutes of Mental Health.

Contact: Alexander Ortega, (614) 293-8547; aortega@sph.osu.edu

Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu

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